Provider Demographics
NPI:1083864144
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:AKRON GENERAL PORTAGE HILLS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:754 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2210
Mailing Address - Country:US
Mailing Address - Phone:330-628-2686
Mailing Address - Fax:330-628-0828
Practice Address - Street 1:754 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2210
Practice Address - Country:US
Practice Address - Phone:330-628-2686
Practice Address - Fax:330-628-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherMEDICAID GROUP #
OH1841239274OtherMEDICARE GROUP NPI #
OH9338635OtherMEDICARE GROUP #